How can a qualified medical examiner affect California workers’ comp?

On Behalf of | Apr 27, 2023 | Workers' Compensation |

As a California worker, you should know that if you suffer a work-related injury or illness, you’re likely entitled to benefits through the state’s workers’ compensation system. During the process of resolving your claim, you may encounter a professional referred to as a qualified medical examiner (QME).

A QME is an impartial medical professional, certified by the California Division of Workers’ Compensation Medical Unit. Their primary role is to evaluate your medical condition objectively if there is a dispute between you and the insurance company about your work-related injury or illness.

When might you need a QME?

Disputes may arise over issues like the extent of your injury, your level of temporary or permanent disability or the necessity of certain medical treatments. If you disagree with the insurance company’s position or the findings of their chosen doctor, you can request a panel of QMEs to perform an independent evaluation.

When you request a panel, the DWC will provide you with a list of three QMEs who are specialists in the field relevant to your injury. You and the insurance company each have the opportunity to strike one doctor from the list. The remaining doctor will then become your QME.

What happens after a QME is selected?

Once you have selected a QME, you’ll need to schedule an appointment for evaluation. It’s crucial to be well-prepared for this appointment. Gather all relevant medical records, including documents from your treating physician, and be prepared to discuss your medical history, symptoms and any limitations your injury has imposed on your work and daily life. Remember, the QME’s report can significantly impact the outcome of your workers’ compensation case.

After the evaluation, the QME will compile a comprehensive report that addresses the disputed issues in your case. This report will help determine crucial aspects such as your eligibility for benefits, the level of your disability and any necessary medical treatments.

By knowing what to expect from the QME process and how to prepare for your evaluation, you can improve the chances of a favorable outcome in your case. If you ever find yourself facing a dispute in your workers’ compensation claim, you must learn how you can protect your rights. Speaking with a legal professional can provide this clarity.

FindLaw Network